THE YALE JOURNAL OF BIOLOGY AND MEDICINE 65 (1992), 639-648 The H2-Receptor Antagonist Era in Duodenal Ulcer Disease

This paper reviews the remarkable impact of H2-receptor antagonists on duodenal ulcer management. The development and the scientific rationale of these agents are presented, and efficacy and safety aspects in the short- and long-term treatment of duodenal ulcer disease discussed. Attention is focused on the possible role of "acid rebound " in ulcer relapse following the withdrawal of therapy and on the clinical relevance of prolonged suppression of acid secretion in patients on long-term therapy. HISTORICAL ASPECTS OF ULCER THERAPY The medical treatment of peptic ulcer has undergone some interesting changes since Pliny extolled the virtues of the "milk of an asse or cow " in the first century A.D. Frequent milk feeds, immortalized by the Sippy regime in the early twentieth century and the Winkelstein milk drip in the mid-1930s, was considered standard ulcer treatment until as recently as 20 years ago. This therapeutic approach has always been closely linked with the use of antacids. Celsus used neutralizing earths for abdominal distress in the first century A.D., Brinton employed bicarbonate prepara-tions in the mid-1850s, and insoluble, non-absorbable antacids provided the basis o